title: Cortisol at the emergency room rape visit as a predictor of PTSD and depression symptoms over time.
abstract: BACKGROUND
  Dysregulation of the hypothalamic-pituitary-adrenal axis, typically reflected by alterations in cortisol responsivity, has been associated with exposure to traumatic events and the development of stress-related disorders such as posttraumatic stress disorder (PTSD) and depression.
  
  
  METHODS
  Serum cortisol was measured at the time of a post sexual assault medical exam among a sample of 323 female victims of recent sexual assault. Analyses were conducted among 235 participants who provided data regarding history of previous assault as well as PTSD and depression symptoms during at least one of the three follow-ups.
  
  
  RESULTS
  Growth curve models suggested that prior history of assault and serum cortisol were positively associated with the intercept and negatively associated with the slope of PTSD and depression symptoms after controlling for covariates. Prior history of assault and serum cortisol also interacted to predict the intercept and slope of PTSD and depression symptoms such that women with a prior history of assault and lower ER cortisol had higher initial symptoms that decreased at a slower rate relative to women without a prior history and those with higher ER cortisol.
  
  
  CONCLUSIONS
  Prior history of assault was associated with diminished acute cortisol responsivity at the emergency room visit. Prior assault history and cortisol both independently and interactively predicted PTSD and depression symptoms at first follow-up and over the course a 6-month follow-up.
authors.affiliation: Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Walsh
authors.forename: Nicole R
authors.initials: NR
authors.lastname: Nugent
authors.forename: Amelia
authors.initials: A
authors.lastname: Kotte
authors.forename: Ananda B
authors.initials: AB
authors.lastname: Amstadter
authors.forename: Sheila
authors.initials: S
authors.lastname: Wang
authors.forename: Constance
authors.initials: C
authors.lastname: Guille
authors.forename: Ron
authors.initials: R
authors.lastname: Acierno
authors.forename: Dean G
authors.initials: DG
authors.lastname: Kilpatrick
authors.forename: Heidi S
authors.initials: HS
authors.lastname: Resnick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003863:Depression / Q000097:blood / Q000175:diagnosis*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011902:Rape; D013313:Stress Disorders, Post-Traumatic / Q000097:blood / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone
keywords: Cortisol; Early intervention; Hypothalamic-pituitary-adrenal axis; PTSD; Sexual assault